One cause of shoulder joint pain is friction of the rotator cuff between the coracoacromial ligament (C-A
lig
. ) and the greater tuberosity of the humerus. In those cases, most surgeons release the C-A
lig
. by an open operative procedure. Scars of the shoulder area, however, cause anxiety for females and early rehabilitation is restricted by surgical invasion.
If the C-A
lig
., however, could be safely incised under endoscopic vision, a wide skin incision would not be necessary. Recently, we developed a new operative procedure for subcutaneous C-A
lig
. release under the Universal Subcutaneous Endoscope (USE). Twentynine patients (23 females and 6 males), or forty-one shoulders, underwent subcutaneous release of the C-A
lig
. at the Japanese Red Cross Medical Center. The age of the patients ranged from nineteen to sixty-nine years (mean 51.9 years).
The operation is carried out under a local anesth e sia using ten milliliters one percent lidocaine solution, which is applied to the anterior part of the shoulder joint. The USE is then gently inserted between the C-A
lig
. and the rotator cuff. We observe the C-A
lig
. and rotator cuff. A retrograde hook knife is introduced along the side of the scope from the previously made skin incision. The C-A
lig
. is released under complete endoscopic vision. The skin incision is closed with a single stich which completes the operation.
The following day, patients are encouraged to perform gentle active range of motion exercises. Almost all patients reported the disappearance of the spontaneous pain at the shoulder joint and an increased range of shoulder joint motion due to the disappearance of the pain on motion. All of the patients were satisfied with the results of the operation.
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